Analyst-Billing Integrity

Job Requirements

Position Summary

The Billing Integrity Analyst will provide professional skills necessary for insuring compliance relating to Medicare billing requirements for both facility and professional billing processes, audit related processes for compliance, work with IT to ensure all appropriate build and edits are in place and communicate and update staff on changes as they relate to the new and/or updated billing requirements. Provides input to Revenue Cycle Director(s) on policies and procedures to enforce compliance regulations and CMS guidelines, decision making and problem-solving activities related to compliance programs. Responsible for review/research of all Medicare and/or Payer’s new requirements, updates and/or changes that effect billing to determine the items that require action. Billing Integrity Analyst is responsible for researching complex payor claim edits including but not limited CCI, MUE, MAU as well as complex payer denials and working closely with our Denials Manager on recommendations for resolution. The Billing Integrity Analyst needs to possess a strong knowledge of coding/billing regulations and guidelines. This position will work closely with our Health System compliance department to ensure the integrity of the billing process as it relates to compliance. Serve as the Revenue Cycle lead for the ECC Compliance Committee and other pertinent committees/workgroups. Functions as the primary resource to our clinical departments for billing compliance and coordinates all necessary communication regarding billing changes/updates based on the rules and regulations.

Must have excellent communication skills and work well as a member of the Revenue Integrity team. Develop and maintain a tracking system for all reviewed documentation and outcomes.

Minimum Requirements

Education

• Bachelor’s Degree
• Seven years of relevant experience will be considered in lieu of the education degree requirement
  
  

• Minimum of three years of experience in Hospital or Professional billing, Medical records or Charge Audit
• Demonstrated general knowledge of billing and coding rules and regulations for governmental and managed care payers.
  
  

• N/A
  
  

• Bachelor’s degree
  
  

• Manager or Coordinator experience
• 2+ years’ experience with reporting analysis
  
  

• CPC, RHIT or equivalent coding certification
• MS Office experience
• NOTE: These bulleted items are intended to describe the essential functions of the job and are not intended to be a complete list of all responsibilities. Skills and duties may vary dependent upon our department. Other duties may be assigned as required.
  
  

• Working knowledge of all Revenue Cycle-Business Services Department processes and procedures related to Billing compliance, coding edits etc.
• Research coding, coverage, medical necessity and other compliance issues for all payers related to charging/billing.
• Monitors WPS/Palmetto GBA and CMS for updates that affect charge capture and billing requirements.
• Attend educational sessions/seminars directly related to area of responsibility as requested by Director.
• Prepares and presents reports detailing the routine claim audits/reviews and transaction testing performed to support departmental compliance initiatives.
• Work Closely with our Revenue Integrity team and Charge Master Analyst regarding new services as it relates to charging/billing.
• Maintains a high level of involvement in the day-to-day activities related to areas of responsibility.
• Assists Denials Management team, as requested, on Outpatient appeals such as but not limited to Medical Necessity edits/denials.
• Must be able to work well with Department managers, Clinical billing staff, departments, and other internal or external customers
• Must be able to effectively serve in a lead role with the various teams throughout the health system
• Attention to detail, excellent organizational skills
• Must be self-directed, motivated and able to work independently
• Must be flexible in responsibilities and work schedule